Health insurance enrollment now open

Year three of the Affordable Care Act enrollment began Sunday with more organizations helping local people sign up for coverage, but fewer companies offering plans in Alachua County.

For the 2016 enrollment cycle, the WellFlorida Council, the Epilepsy Foundation of Florida and, starting this year, Meridian Behavioral HealthCare, will each use federal grant monies to pay for navigators to assist people in Alachua County and surrounding counties to sign up for coverage.

This year, the Obama administration, Affordable Care Act advocacy groups and navigators are trying to reach Florida residents who remain uninsured, but qualify to receive the taxpayer-funded credits that help cover the costs of ACA insurance. An estimated 825,000 of the 2.8 million uninsured Floridians are in that situation, according to Kaiser Family Foundation research.

Lauren Vagelakos, coordinator of the WellFlorida Council navigator program, said navigators also will have an increased focus on helping people use their coverage, with discussions on what is covered, what doctors are in the plan and how to deal with insurers.

“It’s about getting the most out of your coverage, not just getting coverage,” she said.

About 90 percent of the nearly 1.6 million Florida residents who enrolled or re-enrolled in an ACA plan last year received financial assistance through taxpayer-funded tax credits.

A U.S. Department of Health & Human Services report released Friday afternoon projected that 80 percent of the Florida residents enrolled in ACA coverage could find plans for a monthly premium of $75 or less after tax credits and 84 percent could find plans for $100 or less a month after tax credits.

If the availability of those credits is the carrot for getting coverage, the stick for not getting ACA insurance is growing larger this year.

For those who are not exempt from the ACA individual mandate and do not get coverage, the financial penalty is rising from either 2 percent of household income or $325 to 2.5 percent of household income or $695, whichever is higher.

“It is getting to the point where they want to get you to pay for the health care plan rather than pay the penalty and end up paying a lot to the government and getting nothing for it,” Vagelakos said.

Alachua County residents getting ACA coverage for 2016 will have more options than 2014 but fewer than last year in terms of the companies offering plans.

In 2014, Florida Blue, the state’s largest insurer, was the only company offering ACA plans in Alachua County. Last year, Florida Blue was back and UnitedHealthcare and Wisconsin-based Assurant joined the Alachua County market.

In 2016, Florida Blue and UnitedHealthcare are offering a combined total of 23 plan options in Alachua County, according to the HealthCare.gov website. Assurant, however is gone. The company pulled out of the ACA marketplace across the country and is getting out of the health insurance market altogether after “higher than expected losses” on ACA plans in 2015 and a $7 million financial loss in the third quarter of 2015, the company said in a press release.

With enrollment starting, the Department of Health and Human Services and the Florida Office of Insurance Regulation are encouraging people who currently have ACA coverage to shop around instead of re-enrolling in their current plan, something that will automatically happen by Dec. 15 if they take no action.

Last Wednesday, the Department of Health and Human Services said a report showed that Florida consumers who re-enrolled in the ACA marketplace last year and switched to a plan with the same level of coverage saved $39 per month after tax credits, or $465 annually.

The Florida Office of Insurance Regulation said consumers should look at more than premium costs when selecting a plan because different plans have different levels of coverage for out-of-pocket costs such as deductibles and co-payments, prescription benefits and the doctors and hospitals in their networks.

Statewide, the HHS says the average premium for the second lowest cost Silver level ACA plan is expected to rise by 1.2 percent, a figure that does not take into account the financial assistance of tax credits. Back in August, state insurance regulators projected a more significant 9 percent premium increase.

Since the ACA individual mandate took effect, Alachua County’s uninsured rate has declined from 20 percent to 14 percent.

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WellFlorida Council, Inc. is a private, nonprofit 501(c)(3) organization created in 1969. We are the state designated local health council for 16 counties in North Central Florida and specialize in health-related consultancy for clients and projects throughout Florida.